Pa. health coverage better

Although more and more people nationwide are going without health insurance, Pennsylvania seems to be bucking the trend.

In 1996, Pennsylvania had the fifth lowest percentage of residents without health insurance among U.S. states.

But that figure, though low nationally, means just over 1 million Pennsylvanians, or 11.1 percent of the state's 10.2 million residents, went without medical coverage during that year, according to figures released by the Washington, D.C.-based Employee Benefit Research Institute.

The state with the highest rate of uninsured persons was Arizona with nearly 28 percent, and the state with the lowest was Wisconsin with 9.5 percent. Nearby Maryland had an uninsured rate of nearly 13 percent and West Virginia weighed in at 17.9 percent.

The Blues are taking credit, at least in part, for the low figures in Pennsylvania.

According to Heidi Irwin of Capital Blue Cross, health-insurance programs developed by Pennsylvania's Blue Cross and Blue Shield plans for children and low-income individuals contributed to the state's high percentage of insured residents.

Paul Fronstin, an EBRI economist who authored the study, agreed that "something" was going on in Pennsylvania. "I can't say it all has to do with the Blues' activities, but their statement is justified at least in part," he said.

He added that the percentage of uninsured individuals nationwide has barely increased since 1993, although the absolute numbers may have risen as a consequence of population increase. But even then, the rate of increase of those without health insurance has slowed down from year to year, Fronstin said.

Irwin pointed out that the Blues, as insurers of last resort, offer insurance to anyone regardless of health condition or occupation. "Wherever possible, we will continue to do our part to keep uninsured numbers as low as possible," she said.

According to the study, nationwide, 82 percent of Americans under the age of 65 had private or public health insurance in 1996. A full 71 percent had private insurance, and 64 percent held it through an employment-based plan. Sixteen percent had public health insurance.

The study also found that the percentage of uninsured Americans has been increasing since at least 1987.

According to Fronstin, since 1993 the number of individuals falling under Medicaid coverage has gone down as a percentage of the total. "People are being moved out of public-sector health insurance," he said.

He believes this is part of a larger trend. "More sick people and uninsured are putting interesting pressures on the health-care system," he said.

Uninsured people, in particular, put greater pressure on the system because they tend to use more expensive care, such as emergency-room care which taxes pay for, he said.

Although she was pleased to hear that Pennsylvania's numbers are impressive compared to most of the rest of the nation, Diane McCormick still thought the state's uninsured rate was too high. "If the figures are correct, then 11.1 percent is still a big number," said the spokeswoman for state Minority Whip Rep. Ivan Itkin, D-Pittsburgh, who is expected to run for governor against Gov. Tom Ridge.

"Despite all that, Blue Cross and Blue Shield have still filed for rate hikes," McCormick said. And we can only wonder what the figures will look like for 1997 if another study should be done, she added.

Rep. William R. Lloyd, D-Somerset, admitted he was surprised by Pennsylvania's uninsured figures. "I'm not sure how those figures were arrived at and would want to see the way they were calculated," he said. Assuming the numbers are correct, however, Lloyd thinks the state should develop a program to remedy the situation.

"We should develop a program for adults similar to the Childrens Health Insurance Program program, go to the Blues and find out how much it would cost to have the state pay for a bare-bones package for some people." CHIP is a state-funded program that provides free and low-cost children's health insurance to families lacking Medicaid or employment-based coverage.

"What if we took $35 (million) or $40 million out of the surplus and spent it on that?" Lloyd asked.

The fact that more people are uninsured has little to do with public health and has more to do with the fact that health insurance is generally linked to employment, said economist Bill Styring, a senior fellow at the Hudson Institute, a public policy think-tank in Indianapolis.

"People are usually uninsured when they are unemployed," Styring said, "and if you look over time, say six months, and then ask the question 'to what extent are people uninsured?' then you'll get a somewhat different answer."

A lot of people today, such as young parents or young singles, make a conscious decision not to be insured, he said. "The argument that being uninsured is a catastrophe really is not correct," he said. "In fact, it may be a perfectly rational choice."

Some employed persons voluntarily forego employer-sponsored health insurance coverage, another recent study found. In the Medical Expenditure Panel Survey, taken by the Rockville, Md.-based Agency for Health Care Policy and Research, an arm of the federal government, co-authors Barbara Schone and Philip Cooper found that as many as 6 million Americans chose not to accept health insurance, even when it was offered to them.

The study found that although the number of workers offered health insurance through their employer rose significantly between 1987 and 1996, the number of workers declining that coverage jumped by a staggering 140 percent. Employees declining coverage tended to be under age 25, Hispanic or black, not married, or those earning under $7 per hour.

Schone believes a number of factors have contributed to the phenomenon. "Many workers decline coverage because it has become too costly," she said.

Her study also blamed declining real incomes, higher employee contribution rates, state-level mandates which have pushed up health insurance costs and expanded Medicaid coverage for employees opting not to be covered.